1. Field of the Invention
The present invention pertains to a magazine that stores a needle and an attached length of suture pre-tied in a knot on the magazine. The invention also pertains to the method of using the magazine in loading the needle onto a stitching surgical instrument and in loading the tied length of suture onto a suture dispensing surgical instrument.
2. Description of the Related Art
Various different types of surgical instruments specifically designed for use in minimally invasive surgery are known in the prior art. These instruments are designed for use in laparoscopic surgical procedures where small incisions are made and a remote surgical site within the body is accessed through a cannula inserted through the incision.
One such surgical instrument is the Auto Suture.RTM. Endo Stitch.RTM. of United States Surgical Corporation. This instrument is comprised of an elongate tube having a pair of opposed handle levers at its proximal end and a pair of opposed arms at its distal end. The pair of arms project from the distal end in a V-shaped configuration in the at rest position of the arms. The surgeon squeezes the opposed handle levers at the instrument proximal end to cause the pair of arms to pivot through arcs toward each other at the instrument distal end. Each of the arms have apertures in their opposing surfaces that contain mechanisms for gripping a needle specifically designed for use with the instrument.
The needle has a slight curvature and tips at its opposite ends. A length of suture is attached to the needle intermediate its ends. When grasping the needle with the instrument, the needle is first positioned between the opposing surfaces of the instrument arms. The handle levers of the instrument are then manipulated toward each other to cause the two arms to pivot through their arc segments toward each other. The points at the needle opposite ends are received into the apertures in the instrument arms as the arms move toward each other. The gripping mechanism in one of the arms grasps the tip of the needle inserted into the aperture of that arm. When the handle levers are released causing the pair of arms to pivot back to their at rest positions where the arms form the V-shaped configuration, the needle remains grasped in the aperture of the one arm. Subsequent manipulation of the instrument handles toward each other will cause the needle to be passed back and forth between the apertures of the two arms with the grasping mechanisms of the two arms alternatively grasping the opposite tips of the needle.
The above-described instrument is specifically designed to be inserted through a cannula and used in placing stitches at a remote location within the body. In use, the body tissue to be stitched is positioned between the arms with the arms in their at rest V-shaped configuration. The handle levers are manipulated toward each other by the surgeon causing the exposed needle tip to pass through the tissue and into the aperture of the instrument arm not holding the needle. That arm then grasps the needle tip inserted into its aperture. The handle levers are then manipulated by the surgeon to cause the arms to return to their at rest, V-shaped positions. This causes the arm now grasping the needle to pull the needle and the attached length of suture through the tissue thereby forming a first stitch in the tissue. The procedure is repeated passing the needle through the tissue and alternatively grasping the needle with the two arms of the instrument. When the number of desired stitches have been placed, the suture ends may be tied off by any of several means. For example, the needle can be cut from the suture and removed and the suture tied in a knot at the surgical location, usually using conventional graspers.
Many prior art instruments have been developed to facilitate tying knots in suture material at surgical sites located in remote areas that are difficult to access. Several of these instruments are specifically designed for use in laparoscopic surgical procedures where the instrument is inserted through a cannula to the surgical site. An example of such an instrument is that disclosed in U.S. Pat. No. 5,391,176, incorporated herein by reference. Other examples of surgical instruments of this type that are specifically designed for tying a knot in a length of suture at a remote location are disclosed in pending U.S. patent applications Ser. No. 08/277,987, filed Jul. 20, 1994, now U.S. Pat. No. 5,527,323 and Ser. No. 08/377,362, filed Jan. 24, 1995, both of which are assigned to the assignee of this application and both of which are incorporated herein by reference. Generally, the knot-tying instruments of this type are comprised of an elongate tube having opposite proximal and distal ends and an interior bore extending through the tube and dimensioned sufficiently large for insertion of another surgical instrument therethrough. The suture-tying instrument is loaded with a length of suture wrapped around its distal end. The length of suture is pre-tied on the distal end of the instrument in one or more knots. A free end of the length of suture extends from the pre-tied knots and is secured to the length of the knot-tying instrument. The opposite end of the length of suture is attached to a needle.
In use of the suture-dispensing instrument, the distal end of the instrument is first inserted through the cannula to position the distal end at the surgical location where it is desired to place one or more stitches in body tissue. The needle is grasped by a separate surgical grasper and passed through the tissue the desired number of times to place the desired stitches. The needle, with the length of suture still attached, is then removed from the surgical site through the interior bore of the knot-tying instrument. The loops of suture wrapped in a knot on the distal end of the instrument are then displaced off the instrument over the length of suture extending from the stitches. The suture extending from the knots is then pulled tight, thereby forming a knot in the suture at the location of the stitches.
Using the Auto Suture.RTM. Endo Stitch.RTM. in combination with the above-described knot-tying surgical instrument enables the surgeon to easily place a desired number of stitches at a remote surgical location and then tie a knot in the suture. In combination, the interior bore of the knot-tying instrument must be dimensioned sufficiently large to insert the Auto Suture.RTM. Endo Stitch.RTM. stitching instrument through the interior bore of the knot-tying instrument so that its arms project from the distal end of the knot-tying instrument. The needle with the attached length of suture specifically designed for use with the stitching instrument is then attached to one of the arms of the instrument in the manner described above. However, in order to use these two instruments together taking full advantage of the benefits offered by the two instruments, the length of suture extending from the needle must then be wrapped in a knot on the distal end of the suture-dispensing instrument and the free end of the suture then extended from the knot and secured to the knot-tying instrument.
A magazine apparatus that could be used to quickly load a needle onto the stitching instrument and then load a length of pre-tied suture onto the end of the knot-tying instrument would significantly enhance the benefits provided to the surgeon by these two instruments.